King's College, London, UK.
J Am Coll Cardiol. 2012 Aug 21;60(8):756-65. doi: 10.1016/j.jacc.2012.02.075. Epub 2012 Jul 18.
The goal of this study was to determine the diagnostic accuracy of dynamic 3-dimensional (3D) whole heart myocardial perfusion cardiovascular magnetic resonance (CMR) against invasively determined fractional flow reserve (FFR) and to establish the correlation between myocardium at risk defined by using the invasive Duke Jeopardy Score (DJS) and noninvasive 3D whole heart myocardial perfusion CMR.
3D whole heart myocardial perfusion CMR overcomes the limited spatial coverage of conventional two-dimensional perfusion CMR methods and allows estimation of the extent of ischemia. The method has shown good diagnostic accuracy for the detection of coronary artery disease (CAD) as defined by using quantitative coronary angiography. However, quantitative coronary angiography does not provide a functional assessment of CAD as available from pressure wire-derived FFR. In the catheter laboratory, the DJS can complement FFR to estimate the myocardium at risk.
Fifty-three patients referred for angiography underwent rest and adenosine stress 3D whole heart myocardial perfusion CMR at 3-T. Perfusion was scored visually on a patient and coronary territory basis, and ischemic burden was calculated by quantitative segmentation of the volume of hypoenhancement. FFR was measured in vessels with ≥50% severity stenosis and an FFR <0.75 considered as hemodynamically significant. The DJS was calculated from the coronary angiograms to quantify the myocardium at risk.
FFR was measured in 64 of 159 coronary vessels, and 39 had an FFR <0.75. Sensitivity, specificity, and diagnostic accuracy of CMR for the detection of significant CAD were 91%, 90%, and 91%, on a patient basis and 79%, 92%, and 88%, respectively, by coronary territory. There was a strong correlation between the DJS and ischemic burden on CMR (p < 0.0001; Pearson's r = 0.82).
3D whole heart myocardial perfusion CMR accurately detects functionally significant CAD as defined by using FFR and provides an assessment of ischemic burden in agreement with the invasive DJS. The accurate detection of significant CAD combined with an estimation of ischemic burden by using 3D myocardial perfusion CMR holds promise for noninvasive guidance of therapy and risk stratification of patients with CAD.
本研究旨在确定动态三维（3D）全心脏心肌灌注心血管磁共振（CMR）与经导管测量的血流储备分数（FFR）的诊断准确性，并建立通过侵入性杜克危险评分（DJS）和非侵入性 3D 全心脏心肌灌注 CMR 定义的危险心肌之间的相关性。
3D 全心脏心肌灌注 CMR 克服了传统二维灌注 CMR 方法的空间覆盖范围有限的问题，并允许估计缺血范围。该方法在使用定量冠状动脉造影术检测冠状动脉疾病（CAD）方面显示出良好的诊断准确性。然而，定量冠状动脉造影术不能提供压力导丝衍生 FFR 所提供的 CAD 的功能评估。在导管实验室中，DJS 可以补充 FFR 来估计危险心肌。
53 例因血管造影而转诊的患者在 3T 上接受静息和腺苷应激 3D 全心脏心肌灌注 CMR。在患者和冠状动脉区域的基础上对灌注进行视觉评分，并通过体积低增强的定量分割计算缺血负担。在狭窄程度≥50%的血管中测量 FFR，FFR<0.75 被认为具有血流动力学意义。从冠状动脉造影中计算 DJS 以量化危险心肌。
在 159 支冠状动脉中有 64 支测量了 FFR，其中 39 支 FFR<0.75。CMR 检测有意义 CAD 的患者的敏感度、特异度和诊断准确性分别为 91%、90%和 91%，冠状动脉区域分别为 79%、92%和 88%。DJS 与 CMR 上的缺血负担之间存在很强的相关性（p<0.0001；Pearson's r=0.82）。
3D 全心脏心肌灌注 CMR 准确检测到用 FFR 定义的功能意义上的 CAD，并提供与侵入性 DJS 一致的缺血负担评估。3D 心肌灌注 CMR 准确检测有意义的 CAD 并通过其估计缺血负担，为 CAD 患者的非侵入性治疗指导和风险分层提供了希望。
